M A Y O C L I N I C : C O M M I T T E D T O P R O V I D I N G A N S W E R S

P A T I E N T C A R E We deliver answers that comfort our

patients and ease their concerns. M E D I C A L R E S E A R C H We

pursue answers that enable us to predict, prevent and

treat diseases. M E D I C A L E D U C A T I O N We share answers that

advance patient care worldwide.

WHAT IF MY HEART CAN’ T BE F IXED?: PRISCILL A FRENCH 4 · AND THEN THE Y WERE T WO: THE CARLSEN FAMILY 12 ·

ANSWERS IN PAT IENT CARE 2 · BUILDING TRUST: L IVE WELL . THINK WELL . 2 · REPORTER GETS THE STORY OF H IS L IFE:

DAVE SMI TH 3 · ANSWERS IN MEDICAL RESE ARCH 3 · EVERY THING BUT THE RISK : MULT IDISCIPL INARY S IMUL AT ION

CENTER 4 · ANSWERS IN MEDICAL EDUCAT ION 4 · 2006 F INANCIAL REPORT 5 · COMMUNI T Y REL AT IONS REPORT

5 · OUTCOMES THAT MAT TER: REPORT ON QUAL I T Y CARE 58 · BOARD OF TRUSTEES 6 · THE Y E AR AHE AD 6

Mayo Clinic will provide the best care

to every patient every day through integrated

clinical practice, education and research.

O U R M I S S I O N

PEOPLE HAVE ALWAYS COME TO MAYO CLINIC FOR ANSWERS.Their questions are variations on one basic request:

“Can you help me?”

Can you help me stay healthy? Can you help me face this diagnosis and treat my disease? Can you help me overcome this injury?

Mayo’s answer to those questions has been the same for

more than 100 years: “We will do our very best.” Mayo

Clinic’s mission is to provide the best care to every patient

every day through integrated clinical practice, education

and research.

Mayo Clinic uses a team approach to answering questions.

Our doctors, nurses and allied health staff answer patients’

questions on-site and online. Our educators ask and answer

questions in our classrooms, conferences and publications.

Our researchers seek answers to biomedical questions and

then translate those answers into new treatments for patients.

At its core, Mayo Clinic is a learning organization —

learning from each interaction, generating new knowledge,

disseminating that knowledge and continuing the cycle.

We are continuously learning so that we can help patients

understand their conditions, overcome obstacles, and

improve their health and their lives.

Helping patients is the reason Mayo Clinic exists. We

are honored by the trust placed in us and committed

to providing answers and hope.

Sincerely,

D E N I S A . C O R T E S E , M .D.P R E S I D E N T A N D C H I E F E X E C U T I V E O F F I C E R

M AYO C L I N I C

Priscilla French surprised herself in late August 2005 when she ran out

of breath in midsentence. Energetic and active at age 59, she lived in the

Phoenix area and worked in tourism sales, so gasping for air between words

soon led her to consult a physician.

Her physician prescribed a diuretic to treat a trace of fluid on her lungs,

saying her breathing should clear up soon. “I thought I had something that

would go away in two days,” French recalls. Instead, she encountered more

surprises: nearly drowning during a quick swim that instantly made her

breathless and weak; fading strength and energy; and feeling too exhausted

to drive after a routine procedure to drain her lungs.

French’s clinic arranged for her to see a heart specialist in October. She

never made it to the appointment. “It got worse and worse. I couldn’t go in

to work. I just couldn’t breathe,” she says.

“I was the lucky one.

I’m still here.”

W H A T I F M Y H E A R T C A N ’ T B E F I X E D ?P H O E N I X , A R I Z O N A

Priscilla French

French was too weak for major surgery, so Dr. Arabia

performed a procedure to remove the clots, thus

preventing a stroke. He also connected two ven-

tricular assist devices (VADs) to her heart to restore

normal pumping and help French regain strength.

Two days later, French awoke to find herself in

the Cardiac Intensive Care Unit. Dilated cardio-

myopathy, often undetected until an emergency,

had developed over the years, causing her heart to

expand and weaken. Her older sister, Janice, had

received the same diagnosis seven years earlier

but did not qualify for a heart transplant because

of other smoking-related damage.

Hooked to medical equipment and still fatigued,

French felt unrecognizable. “I was just a totally

different person,” she says. After six days with

VAD-powered circulation, she was strong enough

to undergo surgery and was placed on the trans-

plant waiting list.

A DRAMATIC BEGINNING The day before French

arrived at Mayo Clinic, the United Network for

Organ Sharing (UNOS), which coordinates the

nation’s transplant system, approved Mayo Clinic

in Arizona for heart transplantation, and the Heart

Transplant Program officially opened at Mayo Clinic

Hospital and Mayo Clinic’s campus in Scottsdale.

Mayo Clinic, whose three campuses perform more

solid organ transplants than any other U.S. medi-

cal center, had announced plans in September 2004

to introduce heart transplantation to Phoenix, the

nation’s fifth-largest metro area. At the time, the

only Arizona hospital performing heart transplants

was in Tucson, 120 miles away.

On Sept. 27, 2005, French’s deteriorating condition

became critical. She remembers struggling for air,

a friend driving her to a local hospital emergency

room, and then events blurred. A cardiologist at the

hospital determined she had heart failure, attached

her to an emergency heart pump, and had her

transferred by ambulance to Mayo Clinic Hospital

in Phoenix.

French arrived at Mayo in grave condition. “With-

out medical treatment, she would have died within

six hours,” says Francisco Arabia, M.D., surgical

director of the Heart Transplant Program at Mayo

Clinic in Arizona. “Her heart was not pumping

much blood. Blood clots were forming inside the

heart because of the low blood flow. We knew she

needed a heart transplant.”

Priscilla French walks a short distance down an area nature trail with her faithful companion, Honey Bunny, right behind.

“There’s no doubt that having a transplant program here in

Phoenix makes it easier for the family in a difficult time.”

Mayo Clinic recruited Dr. Arabia, who had per-

formed 120 heart transplants and assisted on

nearly 200 more, to be surgical director and Robert

L. Scott, M.D., to be medical director; invested in

the latest mechanical circulatory technology for

patients awaiting a transplant; and trained an inte-

grated multidisciplinary team of about 20 people.

HAPPY TO BE ALIVE French’s critical condition put

her near the top of the waiting list. “I didn’t want

somebody to die for me,” she recalls. She felt

anxious, not fearful. “I didn’t think about life and

death. I trusted my doctors.”

Francisco Arabia, M.D. (f ront) + Rober t L. Scot t, M.D.

On Oct. 19, 2005, UNOS contacted Mayo Clinic

with a match — a heart that would be medically

compatible with French. The surgical team, the

medical team and French were ready when the

transport team returned with the heart from a

donor at another medical center. The eight-hour

surgery was complex yet went as planned: A

new heart started beating in the chest of Priscilla

French, the first heart-transplant recipient at Mayo

Clinic Hospital.

She was discharged from the hospital on Nov. 9,

2005. The postsurgical pain slowly faded. She shed

27 pounds after temporarily losing her sense of

taste, a common side effect of heart surgery. Wak-

ing up became a daily blessing. “Every day I’d see

the sun and thank God,” she says.

A DISTINCT NEED FOR TRANSPLANTS In its first year,

the Heart Transplant Program performed 18 trans-

plants — triple the projected number. “There’s no

doubt that having a transplant program here in

Phoenix makes it easier for the family in a difficult

time,” Dr. Arabia says. “When the family is closer,

they’re able to provide more support to the patient.”

The program’s specialized transport team also

helps save lives. “Three times last week they went

to pick up patients who were dying,” Dr. Arabia

says. “We had a 16-year-old male whose heart

stopped twice in the ambulance. We got him on a

VAD within 45 minutes of receiving the call.”

Meanwhile, this highly visible program has brought

more patients with all kinds of heart problems to

Mayo Clinic for all kinds of answers.

ENJOYING EVERY DAY Sixteen months after her

transplant, French lives independently and contin-

ues to gradually regain strength and add activities:

climbing stairs, driving, swimming, traveling. “My

next challenge is hiking,” she says. “I want to get

back into everything I used to do.”

She joined the New Life Society, a group of about

50 transplant recipients, and helped organize a

support group for people who received a new

heart at Mayo Clinic. Her sister Janice died from

cardiomyopathy in August 2006 at the age of 68.

“I was the lucky one,” French says. “She couldn’t

get a heart.”

www.mayoclinic.org/annualreport

French must take immunosuppressive medications

to maintain a delicate balance that prevents her

body from rejecting the new heart and still protects

her from infection. Those pills and a new heart have

made it possible for her to celebrate her 61st birthday

and to build a new life with her faithful companion,

a furry, white lapdog named Honey Bunny.

“I’m still here,” French says with profound appre-

ciation for the magnitude of that simple statement.

“I live every day to enjoy it.”

Colleen Daly woke on Christmas Day 2006 aching from a rib-spreading, muscle-stretching heart trans-plant and the tension of her life-or-death ordeal.

“I hurt so bad — every bone in my body,” says the 51-year-old wife and mother from Spirit Lake, Iowa. “I was scared to death, and I think I had every muscle in my body tensed up.”

Then she received a massage. Stress and aches melted away. “It relaxed me so much,” Daly says. “I actually got rest and got to sleep.”

The Healing Enhancement Program provides massage, music and relaxation therapies to help reduce pain, tension and anxiety for patients undergoing heart surgery at Mayo Clinic in Roches-ter, Minn. The divisions of Cardiovascular Surgery and Complementary and Integrative Medicine developed the pilot program to meet patients’ physical, psychological and spiritual needs. Asa result, patients feel better physically and emo-tionally, sleep better, need less pain medication, and recover more quickly.

“This is the most multidisciplinary effort I’ve ever seen,” says Thoralf Sundt, M.D., a cardiac surgeon on the committee that organized the Healing Enhancement Program. “We’re trying to transform the patient’s hospital experience. The Cardiac Intensive Care Unit doesn’t have to be a scary place. We want to make it a healing environment.”

Although medicine in the United States has been slow to adopt complementary therapies, the Healing Enhancement Program is helping to establish evidence-based practices through research, including a study on the effectiveness of acupuncture in treating nausea, a common problem after heart surgery.

Therapeutic massage remains a pilot pro-gram because it raises the cost of care but is not charged to the patient. Donations designated for the Mayo Clinic Healing Enhancement Program can help ensure this option for heart-surgery patients. Rakesh Suri, M.D., D.Phil., lead surgeon on Daly’s transplant, believes that complementary therapies speed healing and recovery by tapping into the patient’s natural healing ability. Daly had no need for pain medication, experienced no issues with fluid buildup, and was discharged two days ahead of schedule.

“I blame it on the fantastic care,” Daly says. “Things are going great.”

“Do you love your sister?” It’s a question Jesse and Amy Carlsen of Fargo

never tire of asking their daughters, identical twins Abbigail (Abby) and

Isabelle (Belle). Put the question to Abby, she races to her sister and places her

head on Belle’s chest. Ask Belle, and she rests her head on Abby. The sweet

expression of sibling love has become one of the girls’ favorite games, along

with a synchronized pacifier exchange and endless rounds of copycatting

that Amy refers to as “monkey see, monkey do.”

For most parents, these toddler games wouldn’t warrant an entry in the baby

book. But for Jesse and Amy, even normal milestones still feel like miracles.

“We knew we’d found the place

where our girls would get the

kind of care they deserved.”

A N D T H E N T H E Y W E R E T W OF A R G O , N O R T H D A K O T A

Jesse and Amy Carlsen

When Abby and Belle were born conjoined in

November 2005, the Carlsens weren’t sure their

daughters would ever crawl, walk or blow out the

candles on their first birthday cakes. But the couple

was determined to do whatever it took to ensure

their daughters would experience every first. That

determination would lead the Carlsens to Mayo

Clinic, where a dedicated team of physicians,

nurses and allied health staff would work together

to give the Carlsens what they most wanted for

their children: a future.

BEATING THE ODDS The Carlsens’ medical odyssey

began nine weeks into Amy’s pregnancy, when

an ultrasound revealed the possibility that she

was carrying conjoined twins. Two weeks later,

a second ultrasound left no doubt. The couple’s

daughters were joined at the chest and abdomen,

sharing a liver, bile ducts and intestines.

Research suggests that conjoined twins develop in

as many as one in 50,000 pregnancies, but they

account for only one in 250,000 live births. Almost

half of conjoined twins are stillborn; fewer than

half of those born alive survive long enough to be

candidates for separation surgery. In spite of such

bleak statistics, Jesse and Amy were optimistic.

“Much of the situation was out of our hands, but we

knew we could at least remain positive,” says Jesse.

On November 29, 2005, their optimism was

rewarded when Abbigail Lynn and Isabelle Anne

arrived via planned C-section at Abbott North-

western Hospital in Minneapolis. They were

healthy babies, just as Jesse and Amy had prayed

they would be. The couple hoped the rest of their

prayers would be answered as perfectly.

COMING TO MAYO With the girls’ birth behind them,

Jesse and Amy began searching for the right team

to separate Abby and Belle. They had already spo-

ken with staff at two facilities when Jesse called

Mayo Clinic in February 2006. After speaking

with Christopher Moir, M.D., a pediatric surgeon,

the Carlsens decided to take Abby and Belle to

Mayo for evaluation.

“Dr. Moir told me Mayo had the best children’s

liver surgeon, which was important because the

girls shared a liver,” says Jesse. Something else

Dr. Moir said impressed the Carlsens: a decade

earlier, he had led a team that separated two sets

of conjoined twins. If the Carlsens decided to bring

Abby and Belle to Mayo for treatment, many of the

same people would be providing the girls’ care.

“We were impressed by Dr. Moir’s confidence and

Mayo’s experience,” says Jesse. With only 250 sets

of conjoined twins successfully separated, that

experience was a considerable advantage.

The Carlsens packed their bags, planning to spend

a week in Rochester meeting with doctors. But

soon after they walked through the doors of Saint

Marys Hospital, the Carlsens realized their stay in

Rochester would be a much longer one.

“Everyone was prepared for us,” says Jesse. “It

was obvious Mayo had all of its ducks in a row.

We knew we’d found the place where our girls

would get the kind of care they deserved.” That

care was provided by a cast of 70 people, including

plastic, pediatric, bile duct, cardiac and transplant

surgeons; pediatric anesthesiologists; radiologists;

nurses; dieticians; intensive care specialists; physi-

cal therapists; and child life specialists.

While it was the largest team ever assembled at

Mayo Clinic, in many respects the Carlsens’ care

was business as usual.

“We assemble a team for each of our patients,”

says Dr. Moir. “This was a much larger group than

most, but the way we worked together was no dif-

ferent than if we had been caring for a child with

a hernia.”

“When caring for any patient, I figure out what the

defect is and then figure out how to fix it,” says

Ricky Clay, M.D., a Mayo Clinic plastic surgeon

specializing in pediatrics. “The approach was

the same with Abby and Belle. We used the same

techniques we use every day — we just combined

them in a slightly different fashion.”

As the team’s leader, Dr. Moir kept the Carlsens

informed of plans for their daughters’ care. “Dr.

Moir made sure we knew everything the care team

knew,” says Jesse. “Because we aren’t doctors, he

sometimes had to explain things more than once

and it took a lot of his time. But at Mayo, time

isn’t the most important thing — the patients are

the most important thing. The staff made us feel

like our girls were the most important thing in the

world to them.”

“By the day of surgery, we had separated Abby and Belle

hundreds of times in our heads. … We were ready.”

ANSWERED PRAYERS On May 10, 2006, the Carlsens

invited everyone involved in Abby and Belle’s care

to a healing service, which included the blessing

and anointing of Dr. Moir’s hands. Two days later,

those hands — backed by months of prayer and

preparation — would hold the Carlsens’ world.

As Jesse and Amy placed their daughters on an

operating table on the morning of surgery, their

hearts were full of equal parts of hope and fear.

If everything went as planned, the next time they

saw Abby and Belle it would be as two separate

little girls. But if something went wrong, they could

lose one — or even both — of their daughters.

Christopher Moir, M.D.

The odds were on their side. Dr. Moir originally

told the Carlsens there was a 30 percent chance

one or both girls would not survive the surgery.

But after months of studying images of the girls’

anatomy, Dr. Moir felt the risk was less than 5

percent. “By the day of surgery, we had separated

Abby and Belle hundreds of times in our heads,”

he explains. “We knew every aspect of their anat-

omy, and had discussed every possible option for

separating them. We were ready.”

At 4:28 p.m., after approximately eight hours of

surgery, the final piece of tissue connecting Abby

and Belle was cut. A few hours later, Jesse and

Amy saw Abby alone for the first time. Not long

after, they saw Belle. “They looked so good, the

way they were supposed to,” says Jesse. “It was

like they were free.”

After just three and a half weeks of recovery, the

Carlsens returned to their home in Fargo.

“As happy as we were to be going home, we were

really sad to leave Mayo,” says Jesse. “It was hard

to leave the people behind.” So he and Amy were

thrilled when some surprise guests showed up at

Abby and Belle’s first birthday party: Dr. Moir and

his sons, twins Spencer and Logan.

“I believe there was a reason we were led to Mayo

Clinic,” says Jesse. “Our girls got amazing care

from amazing people. We couldn’t have asked for

anything more.”

www.mayoclinic.org/annualreport

Pictured left to right, Belle and Abby Carlsen

On Aug. 8, 2006, identical twins Abygail and Madysen Fitterer were born to Suzy and Stacy Fitterer of Bismarck, N.D. Like another set of twins from North Dakota, Abbigail and Isabelle Carlsen, Abygail and Madysen were conjoined. The Fitterers drew hope from the Carlsens’ story, following news reports and speaking with parents Jesse and Amy Carlsen about their experiences at Mayo Clinic.

“I was so happy they decided to bring their girls to Mayo,” says Jesse. “I knew they would get such great care.” Physicians drew on their recent experience with the Carlsen twins, who were separated May 12, 2006, when caring for Abygail and Madysen.

“The Carlsens helped us get separating conjoined twins down to a standard operating procedure,” says Christopher Moir, M.D., the Mayo Clinic pediatric surgeon who led the teams caring for both sets of twins. “We had the opportunity to take a difficult and unique case

and make it routine, which meant our team knew exactly what to do when the Fitterers arrived.” On Jan. 3, 2007, that team successfully separated Abygail and Madysen. Seven weeks later, the Fitterer family left Mayo Clinic and returned home to Bismarck.

For Dr. Moir, the separation surgeries were meaningful both professionally and personally.

“I choose to work at Mayo because of its unique focus on the patient and its emphasis on teamwork among staff,” he says. “The Carlsen and Fitterer cases are wonderful examples of the best of Mayo Clinic.” And those little girls?

“The girls are all absolutely charming,” says Dr. Moir. “You can tell by the smiles on the girls’ faces that they are well loved and have incredible parents. It was a privilege getting to know both of these families, and I look forward to staying in touch and watching the girls grow up.”

Mayo Clinic brings together teams of physicians, nurses and other allied

health professionals to diagnose and treat medical problems. Thousands of

patients come to all Mayo Clinic locations every day for accurate diagnosis

and the highest-quality care. Most patients are treated on an outpatient

basis. Most patients make their appointments themselves — in most cases,

a doctor’s referral is not necessary.

A N S W E R S I N P A T I E N T C A R E : 2 0 0 6 N U M B E R S + H I G H L I G H T S

• Mayo Clinic collaborated with Gamma Medica

and GE Healthcare to develop a diagnostic device

that is sensitive enough to detect breast tumors

as tiny as one-fifth of an inch in diameter. The

new technique, molecular breast imaging, uses

a dual-head gamma camera system to obtain im-

ages that, unlike mammography images, are not

affected by dense breast tissue.

• A Mayo Clinic team developed a new medical

device that helps patients control their breath-

ing when undergoing computed tomographic

(CT) fluoroscopy-guided biopsies. The Interactive

Breath-hold Control — the first medical device of

its kind — allows physicians to more rapidly and

accurately diagnose patients, reducing the need

for a more invasive surgical biopsy.

• Mayo Clinic Cancer Center researchers (epide-

miologists) found that a radical prostatectomy

can be a safe option for some men over 80 years

old. While some surgeries are traditionally not

offered for patients over a certain age, research-

ers suggest that age should not be the deciding

factor when considering treatment options.

MAYO CLINIC PATIENTS

Total clinic patients* ...............................521,000

Hospital admissions................................135,000

Hospital days of patient care.................619,000

* Rochester, Jacksonville and Arizona only

MAYO CLINIC PERSONNEL(including temporary and supplemental employees)

Staff physicians, medical scientists

and clinical and research associates....3,317

Residents, fellows and students

and other temporary professionals...... 3,235

Administrative and allied health

personnel ...............................................46,656

TOTAL ........................................................ 53,208

Mayo Clinic 26 Annual Report

• Cardiologists at Mayo Clinic devised a new

strategy to improve the effectiveness and safety

of heart stents, which are used to open narrowed

blood vessels and have been the recent subject of

clotting concerns. The novel approach is based

on magnetizing healing cells from the patient’s

blood so the cells are quickly drawn to magneti-

cally coated stents.

• In October, Mayo Clinic and The American

Legacy Foundation announced a collaboration

to bring together the expertise of Mayo Clinic’s

Nicotine Dependence Center and The American

Legacy Foundation’s public health and market-

ing acumen to help smokers who want to quit.

• Mayo Clinic radiology researchers developed

a new technique for using magnetic resonance

imaging (MRI) to accurately measure the hard-

ness or elasticity of the liver. Initial tests show this

technology — MR Elastography (MRE) — holds

great promise for detecting liver fibrosis, a com-

mon condition that can lead to incurable cirrhosis

if not treated in time.

• Mayo Medical Laboratories began offering a

new genetic test to help physicians nationwide

identify patients who are likely to have side effects

from drugs commonly used to treat depression.

Results of the test can help physicians determine

the best treatment choice for their patients.

• Mayo Clinic hosted a cardiac screening event

in Arizona for retired NFL players as part of a

national initiative by the Living Heart Founda-

tion and the National Football League Players

Association. It was held to raise awareness of

potential heart disease related to body mass.

• Radiologists and radiation oncologists at

Mayo Clinic began using tiny glass bubbles

filled with radioactive material to deliver high

doses of tumor-killing radiation directly to liver

tumors. Physicians say the procedure, called ra-

dioembolizatIon or intra-arterial brachytherapy,

is better tolerated than other forms of liver cancer

treatments. It may be the best option for patients

who aren’t candidates for other treatments, such

as surgery or liver transplantation.

• Mayo Clinic ear, nose and throat surgeons

began using angioplasty — a technique long

used to open clogged arteries — as a minimally

invasive option to help open sinuses in patients

who require more than just medicine. The new

outpatient procedure, called balloon sinuplasty,

alleviates symptoms of sinusitis, an inflammation

of the sinus cavities usually due to infection.

• Hematologists in the Mayo Clinic Cancer

Center found that certain patients suffering from

multiple myeloma, a difficult-to-treat cancer of

the blood, may respond positively to bortezomib,

a drug that shows potential to extend their sur-

vival rates by as much as six months. The find-

ings may help researchers target individualized

treatments to patients.

• Researchers from Mayo Clinic found that

occipital nerve stimulation may be an effective

treatment for patients suffering from chronic

migraine headaches. The treatment involves im-

planting a neurostimulator under the skin at the

base of the head, which then delivers electrical

impulses near the occipital nerves via insulated

lead wires tunneled under the skin.

www.mayoclinic.org/annualreport

Alzheimer’s disease — which robs elders of memory, thinking ability and

eventually independence — disproportionately affects African-Americans.

Studies vary, but most research shows that Alzheimer’s disease is 14 percent

to nearly 100 percent more prevalent in African-Americans than in Caucasians.

And little is understood about this huge difference in prevalence.

“… in future prevention and treatment

studies, we must build on these outreach

successes and do even more.”

B U I L D I N G T R U S T T O F I N D B E T T E R A N S W E R S A B O U T A L Z H E I M E R ’ SJ A C K S O N V I L L E , F L O R I D A

Floyd Willis, M.D.

Mayo Clinic doctors and researchers are taking

steps to change that — in churches, sororities,

community centers and other places where seniors

gather to listen and learn how to keep their brain

healthy as they age.

In 2006, Mayo Clinic in Jacksonville launched

Live Well. Think Well., a pilot community outreach

program to promote healthy brain aging. Floyd

Willis, M.D., a Mayo family physician who led the

effort, says the primary goal was to share informa-

tion about memory loss, its disproportionate toll

on African-Americans and how to minimize risk.

GOOD FOR THE BRAIN, GOOD FOR THE BODY Dr. Willis

says the gospel of healthy brain aging might sound

like advice your grandmother would give: eat right,

lose weight if needed, exercise your body and brain,

manage stress, and stay connected to others.

“The good news, call it the cherry on the ice cream,

is that if you lead a lifestyle that is good for the

brain, that lifestyle is also good for the heart,

kidneys and vascular system,” says Dr. Willis. In

fact, risk factors for vascular diseases — high blood

pressure and diabetes — seem to be significant

risk factors for Alzheimer’s in African-Americans.

And those conditions are more prevalent in

African-Americans than in other racial groups.

Doctors, nurses and trained community volunteers

have taken the healthy brain aging message to au-

diences throughout the community. In six months,

they made 30 presentations, reaching 465 people.

Countless more were reached through health fairs,

direct mail and media coverage.

Floyd Willis, M.D., leads a Live Well. Think Well.group session at a Jacksonville Senior Center.

Doris Putman, a retired public health nurse, was

eager to be a volunteer speaker because of person-

al experiences. She’s kept her diabetes in control

for 15 years with healthy choices. She’s also seen

how Alzheimer’s can affect a family; her sister has

the disease. “A healthy lifestyle might not prevent

memory problems, but it can slow them down,”

she says. She also notes that audiences are more

receptive when a peer shares experiences.

Live Well. Think Well. is more than a wellness initia-

tive. It is also about advancing research to find better

treatments and, eventually, a cure for Alzheimer’s

disease, and ensuring that the research represents

all people. At Live Well. Think Well. presentations,

audience members learn about research and how

they can participate.

Mayo Clinic is at the forefront of research looking

at ethnic differences in patients with Alzheimer’s

disease. About 400 Jacksonville-area residents are

part of an ongoing Mayo study that looks at nor-

mal brain aging in African-Americans. One result:

researchers published standards in 2005 to better

diagnose Alzheimer’s disease and other dementia

in the African-American population.

“Many elderly African-Americans, especially those

raised and educated in the South, endured sig-

nificant disparities in educational opportunities,”

says John Lucas, Ph.D., the Mayo neuropsycholo-

gist who led the study. “Previous diagnostic tests

for memory disorders did not take cultural and

educational differences into account.”

Thanks to research participation from members of

the Jacksonville community, doctors nationwide

now can use these new normal aging standards

to better diagnose memory problems in African-

American elders. But many more answers are

needed, about treatment and, one day, a cure.

AFRICAN-AMERICANS UNDERREPRESENTED IN RESEARCH

Throughout Mayo Clinic, there are dozens of studies

under way on Alzheimer’s and memory disorders.

Even in a diverse community like Jacksonville,

African-American elders are underrepresented in

many of Mayo Clinic’s memory disorder research

programs. It’s not a surprise, says Pam Quarles, a

member of the advisory panel for Live Well. Think

Well. The panel meets to provide guidance to the

outreach program.

“People might say you don’t have to worry about

what happened 50 years ago,” says Quarles, who

also serves on the Alzheimer’s Disease Advisory

Committee to the state of Florida’s Department of

Elder Affairs. But for people in their 60s, 70s and

80s, many may be reticent to participate in re-

search because of examples of past poor care and

unethical research involving African-Americans.

Live Well. Think Well. aims to build trust so more

African-Americans consider participating in

research. “When you go out to people on their

territory — repeatedly — and treat them with dig-

nity and respect, it begins to make a difference,”

says Quarles.

Mayo researchers hoped to recruit 54 African-

American elders for several open studies on

neurological and memory disorders during the six-

month outreach program. Many of these programs

had never recruited any African-Americans.

www.mayoclinic.org/annualreport

The initial response was encouraging, says Dr.

Willis. About 80 individuals indicated interest in

participating. Interviews and screenings are under

way to determine if these individuals meet study

criteria. “Frankly, it takes many decades to make

inroads, where for hundreds of years, there have

been barriers,” says Dr. Willis. “To be inclusive of

African-Americans in future prevention and treat-

ment studies, we must build on these outreach

successes and do even more.”

Quarles, whose work with the Alzheimer’s Disease

Advisory Council puts her in contact with 13 state-

supported memory clinics throughout Florida,

says Mayo Clinic is at the forefront in outreach to

elders in Florida. She hopes others follow Mayo’s

lead, both to advance research and to improve care

for African-Americans who have Alzheimer’s. She

notes that African-Americans account for less

than 1 percent of patient services provided at 13

state-supported memory clinics, which includes

Mayo Clinic. Yet, African-Americans are affected

by Alzheimer’s disease more so than Caucasians.

Live Well. Think Well. is a step forward, ensuring

that all people have access to care for memory

disorders, and that research benefits people of all

races and backgrounds. “Building trust is para-

mount,” says Quarles. “And if Mayo is doing it,

why can’t others?”

“When you go out to people on their territory — repeatedly— and treat them with dignity and respect, it begins to

make a difference.” Pam Quarles

At our very core — our genes — we’re 99.9 percent the same. Mayo Clinic researchers are delving into how the tiny difference that makes us unique can affect, and ultimately improve, the preven-tion, diagnosis and treatment of diseases.

This new field of study is called individualized medicine. “We want to better tailor treatments to patients,” says Eric Wieben, Ph.D., director of the Mayo Clinic Genomics Research Center. Research on individualized medicine is under way at all Mayo Clinic locations on health issues such as Alzheimer’s and Parkinson’s diseases, diabetes, cardiovascular disease and chemical dependency. Already, researchers have made discoveries that are improving treatments.

The concept of individualized medicine isn’t new. It begins whenever a doctor takes a detailed family history. Now, emerging technology allows researchers to better understand how genetic differences affect treatment.

BREAST CANCER: Tamoxifen, a drug often used to treat breast cancer, may not be the best treatment option for all women. About 10 percent of Cauca-sian women have genetic alterations that affect the activity of cytochrome P4502D6, a liver enzyme responsible for tamoxifen metabolism. A study led by researchers at Mayo Clinic and the University of Michigan found that these women were twice as likely to have breast cancer relapse.

COLON CANCER: For people who have a common al-teration in gene UGT1A1, the standard dose of a first-line chemotherapy medication used to treat colon cancer causes serious or life-threatening complications. Now, a specialized blood test prior to treatment helps avoid these problems.

DEPRESSION: About 30 percent of patients with major depression disorder don’t improve with the first antidepressant prescribed. A deficiency of the gene Cyp4502D6, which is responsible for metabolizing commonly used antidepressant medications, often is the reason. “Knowing there is a deficiency of Cyp450 is especially helpful for high-risk patients with limited ability to articulate how well the medication is working,” says Dennis O’Kane, Ph.D., Mayo Clinic scientist.

“Our goal is to make individualized medicine a more widespread and routine part of clinical practice,” says Dr. Wieben.

Dave Smith, a reporter and weekend editor for the Fairmont Sentinel, knew

that an insider’s view of Mayo One, Mayo Clinic’s emergency medical

helicopter, would make a great story. Somehow, the timing for a ride-along

was never right.

On Sunday, Oct. 22, 2006, he got the ride. But not as an observer; he was

a patient having a heart attack.

“Learning to live a much healthier life

is going to be a serious challenge for

a hot-dog chomping, coffee-guzzling,

hash-brown loving, fried-chicken

feasting fool like me.”

R E P O R T E R G E T S T H E S T O R Y O F H I S L I F EF A I R M O N T , M I N N E S O T A

Dave Smith

The story he lived to tell is an example of what’s

right in the health care system. From Fairmont

Medical Center’s emergency department to the

Mayo One emergency medical helicopter to the

coronary care unit at Saint Marys Hospital at

Mayo Clinic in Rochester, Minn., his timely care

made for a happy ending — with no permanent

damage to his heart. But a happy ending was not a

foregone conclusion.

At 2 p.m. that Sunday, Smith’s chest began to hurt.

Despite the pain, he went to the newspaper office

to lay out pages, a typical Sunday chore. At 42 years

old, with normal cholesterol and blood pressure

and no history of heart problems, Smith was not

alarmed. “Even to myself, I didn’t want to admit or

say heart attack,” he says.

But the chest pain worsened. His head, neck and

shoulders began to hurt, too. “I’m in a newsroom

with computers,” he says. “So I hit the Internet

quick.” The advice he found at the American Heart

Association’s Web site was ‘call 911.’ That got his

attention. He called his wife Tanya to take him to

the emergency department at Fairmont Medical

Center — Mayo Health System, just minutes away

from the newspaper office.

Immediately, Smith was given aspirin and nitro-

glycerin to relieve his symptoms, says Blake An-

derson, M.D., emergency physician who cared for

Smith. An electrocardiogram and a blood enzyme

test confirmed what symptoms suggested; Smith

was having a heart attack and needed access to

advanced care quickly. “With that information, we

pull the trigger, contact Mayo Clinic and call for

air transport,” says Dr. Anderson.

Mayo One can be in flight within minutes of a dispatch call, 24 hours a day, every day. Like Dave Smith, about one-half of

transports are cardiac patients.

At 4:44 p.m., the calls were made. Mayo One,

based that day in Mankato, Minn., was dispatched.

Within 30 minutes, Smith was in the air, heading

toward Saint Marys Hospital. “We didn’t even

shut the helicopter down when we landed in

Fairmont,” says Todd Emanuel, Mayo One flight

nurse. The helicopter lands just yards from the

Fairmont emergency department.

Emanuel and his partner, paramedic Jessica Fite,

continued the care started in Fairmont. En route,

Smith’s chest pain had diminished, but it wasn’t

gone. Emanuel called Jae Oh, M.D., the cardiolo-

gist on duty at the Saint Marys Coronary Care Unit,

to get approval for additional medications to ease

symptoms. Smith felt good enough to joke with

his caregivers that he was finally going to get his

Mayo One story.

When Smith arrived at Saint Marys at 6 p.m., his

pain was gone. An electrocardiogram indicated

that the immediate danger was over, says Dr. Oh.

The next morning, Mayo cardiologists performed

coronary angiography, which found a 90 percent

blockage in a major coronary artery. During the

procedure, Smith was awake and comfortable as

doctors inserted a long, thin tube with a balloon

tip into an incision in his leg through the artery to

the blockage near the heart. At the blockage site,

the balloon tip was inflated to open the artery. A

metal stent was placed to keep the artery open.

From the emergency physician and nurses in

Fairmont, to the Mayo One dispatcher and flight

crew, to cardiologists and critical care nurses, at

least 30 people provided hands-on care during the

24 hours after Smith’s chest pain began. Smith, an

avid sports fan, says that the coordination and care

was an all-star performance. “The ones that are the

best, practice and play together the most,” he says.

“That’s the feeling I got from them.”

That prompt and coordinated care, which began

with Smith’s choice to seek care quickly, is why

his heart was unscathed. An electrocardiogram

— done before Smith headed home — was normal

and showed no signs of heart damage.

“If a patient seeks treatment in an hour or two of

chest pain, we often can minimize heart damage

or even stop the heart attack,” says Dr. Oh. “If a

patient waits six or seven hours to seek treatment,

there’s going to be major heart damage. Conse-

quences could include shortness of breath, fatigue,

heart failure and potentially fatal arrhythmias.”

Two days later, Smith went home. Donna McMurtry,

R.N., a Fairmont cardiac rehabilitation nurse, and

Fairmont physician Durga Komaragiri, M.D., an

internal medicine specialist, have worked closely

with Smith since the heart attack.

“Donna [my nurse] gave me the wonderful and beautiful

news that I should never shovel snow again.” Dave Smith

“Donna gave me the wonderful and beautiful

news that I should never shovel snow again,” says

Smith, whose sons, ages 9 and 13, now handle the

chore. McMurtry also encouraged more exercise,

healthier eating and losing weight. By mid-January

2007, Smith had attended 15 cardiac rehabilitation

sessions in Fairmont, where supervised exercise

was combined with learning about heart-healthy

living. He’d lost about 12 pounds.

The changes aren’t easy, wrote Smith in a column

in the Fairmont Sentinel. “Learning to live a much

healthier life is going to be a serious challenge

for a hot-dog chomping, coffee-guzzling, hash-

brown loving, fried-chicken feasting fool like me,”

he wrote.

But he’s doing it. He’s become an evangelist on

seeking prompt care for heart attack symptoms.

“I can’t stress it enough,” he says. “If you think you

might be having a heart attack, it’s not that big of a

deal to go in and find out that you’re not.”

Thinking back to when his chest pain began, Smith

says, “I could have stayed on my feet and worked

longer.” He credits divine intervention — he’s also

a pastor of the Fair Lakes Apostolic Fellowship in

Fairmont — as well as the Internet for his decision

to seek care quickly. “Once I saw these were heart

attack symptoms, the idea of gutting it out was

gone,” he says. “I don’t want to be a tough guy. I’m

going to be the alive guy.”

As part of his cardiac rehabilitation,Dave Smith is walking as much as he can. The sidewalks of Fairmont are slushy with melting

snow in March, but that won’t stop him.

www.mayoclinic.org/annualreport

Long before paramedic Josh Toms joined Gold Cross Ambulance Service in Duluth, Minn., he knew the role, importance and challenges of first responders. His parents, Mark and Brenda Toms, are longtime volunteer emergency responders in largely rural Fredenberg Township, about 20 min-utes north of Duluth. At age 18, Josh completed training and joined them.

“When a pager went off, the house emptied,” says Mark Toms, chief of the Fredenberg Volun-teer Fire Department. At car crashes and medical emergencies in the township, Fredenberg first responders have long worked side by side with paramedics from Gold Cross, part of Mayo Clinic Medical Trans-port. The Fredenberg team often arrives first, beginning treatment to stabilize patients until paramedics arrive.

The Fredenberg emergency response vehicle was a 1978 converted Air Force van. “It was definitely time to update,” says Mark. But in a township of 1,400 people, finding the dollars to upgrade was nearly impossible.

Josh, who joined Gold Cross last year, alerted his dad to a possible solution. Each year, Gold Cross donates retired ambulances to first responders, schools or other organizations, with priority given to organizations in the areas Gold

Cross serves. The donations are another way Gold Cross gives back to communities.

Josh put in a request for Fredenberg. After a six-month wait, Fredenberg’s “new” emergency vehicle was ready to roll in November 2006, freshly painted and a fire department insignia on each door.

“It was a welcome gift,” says Mark. In spite of tender-loving maintenance, Fredenberg’s old emergency vehicle wouldn’t always start. In 2006, Gold Cross, with bases in 10 communities in Minnesota and Wisconsin, also donated vehicles to the American Red Cross, Southeast Minnesota Chapter, Rochester, Minn.; South Central College, Mankato, Minn.; and Mid-way Township First Responders, near Duluth. In the last six years, Gold Cross has do-nated 33 well-maintained, used vehicles to first responders and schools. But the donation to the Fredenberg Volunteer Fire Department marked a first and a bit of a role reversal — a son handing over the keys to his dad.

Biomedical research at Mayo Clinic includes outstanding programs in

laboratory science, clinical research and population studies –– all of

which lead to new treatments and a better understanding of disease. This

coordinated effort helps Mayo quickly translate research discoveries into

better care for patients. Most Mayo medical staff participate in research

activities in addition to their medical practice.

A N S W E R S I N M E D I C A L R E S E A R C H : 2 0 0 6 N U M B E R S + H I G H L I G H T S

• A Mayo Clinic researcher discovered a target

in malaria-carrying mosquitoes that may aid in

development of pesticides that are toxic to some

mosquito species but not harmful to mammals.

The findings could offer a safer and more effec-

tive control of mosquito-borne diseases such as

malaria.

• A Mayo Clinic study found that difficulties in

the heart’s ability to fill with blood are common

causes of heart failure. The study is the first large,

community-based study to clarify this aspect of

heart failure. Researchers believe that as a result

of the findings, heart failure can likely be man-

aged more effectively to identify and treat those

at highest risk of dying from heart disease.

• An international research collaboration led by

Mayo Clinic — one of the largest studies of its

kind — found strong evidence that a genetic risk

factor may account for 3 percent of Parkinson’s

disease cases. The study provides evidence that

variations in the alpha-synuclein gene contrib-

ute to Parkinson’s risk across several populations

worldwide.

RESEARCH PERSONNEL

Mayo physicians and medical scientists ......310

Temporary professionals ................................521

Allied health personnel ............................... 1,880

TOTAL ...........................................................2,711

Mayo’s integrated practice encourages and enables many to play a role in advancing medical research. The number of staff with some part of their time dedicated to research activities totals more than 6,000.

Mayo Clinic 26 Annual Report

• Mayo Clinic researchers, working with col-

leagues in Germany, devised a multilevel safety

feature for viruses used to treat cancer, making

cancer-killing viruses more specific to cancer

tumor cells and improving the therapeutic effec-

tiveness of viruses. They did this by engineering

a modified measles virus that turns on only in

the presence of secretions specific to malignant

cancer cells. This is a key advance because it

provides a way to design a therapeutic virus that

is safe, stable and that reliably targets and kills

cancer cells.

• Mayo Clinic, in collaboration with GE Health-

care, began a new program for clinical develop-

ment of high-field magnetic resonance imaging

(MRI) of the abdomen, heart, breast and muscu-

loskeletal system using a new, state-of-the-art 3T

MR system. The new MR system was installed in

Mayo’s Body MRI Advanced Development Unit

in Rochester.

• In October, InNexus Biotechnology, a publicly

held company, moved into space in the Mayo

Clinic Collaborative Research Building on the

Mayo Clinic campus in Arizona. This first-of-

its-kind facility joins multiple strategic partners

under one roof to focus on developing and sup-

porting medical research and education.

• A study led by Mayo Clinic demonstrated that

mild cognitive impairment, a memory disorder

considered a strong early predictor of Alzheimer’s

disease, not only results in behavioral symptoms

but also structural changes that can be identified

in the brain. The study is one of the first autopsy

studies of mild cognitive impairment.

• Mayo Clinic researchers discovered that a com-

mon imaging technique when combined with

genetic testing nearly doubles the effectiveness

in detecting the presence of a potentially deadly,

inherited heart condition called hypertrophic car-

diomyopathy (HCM). Currently the genetic test

correctly detects HCM only 40 percent of the time.

But coupled with echocardiography imaging, the

detection power of the test nearly doubles.

• Mayo Clinic broke ground for a new building

in Rochester that will house advanced imag-

ing research. Mayo received a gift of $7 million

from The Opus Group, a commercial real estate

development and management company, to sup-

port construction of the facility. Research in the

Mayo Clinic Opus Imaging Research Building

will focus on discovery and development of new

medical imaging technologies and integration of

innovative imaging techniques into patient care.

• Mayo Clinic researchers took a step in tar-

geting childhood obesity with the anti-obesity

concept-project called The Classroom of the Fu-ture. Researchers monitored children’s activity

levels in a ‘normal’ classroom setting and then

compared it to activity in the “classroom of the

future,” where movement is integrated into the

children’s entire learning experience.

• Mayo Clinic researchers found that cognitively

normal, elderly people who developed depression

were at increased risk of developing mild cogni-

tive impairment. When viewed as a spectrum of

cognitive functioning, mild cognitive impairment

falls between normal brain aging and dementing

illnesses such as Alzheimer’s disease.

www.mayoclinic.org/annualreport

In a busy operating room, monitors beep and hum, pagers go off, the

surgical team holds several conversations at once, the telephone rings,

staff members walk in and out. In short, it’s not an ideal environment for

thoughtful concentration. But, that’s exactly what’s asked of surgeons in

many operating room situations. How can new surgeons develop the poise

required of them? According to David Farley, M.D., a Mayo Clinic surgeon

and vice chair for education in Mayo’s Department of Surgery in Rochester,

Minn., the answer is practice, practice and more practice.

“In this setting, it’s okay to make

a mistake. In fact, sometimes it’s

great because it gives us a perfect

opportunity to teach.”

E V E R Y T H I N G B U T T H E R I S KR O C H E S T E R , M I N N E S O T A

David Farley, M.D.

“We want our students to have training in the

operating room, so they understand what’s

happening around them and are familiar with all

the sights and sounds in there,” says Dr. Farley.

“Surgeons are asked to make crucial decisions in

this environment, and it’s not an easy one to work

in. People have to learn to think on their feet.”

Instead of just putting surgical residents in an

operating room and allowing them to watch what’s

going on or participate in a limited way, through its

Multidisciplinary Simulation Center, Mayo Clinic

can immerse students in the operating room envi-

ronment, allowing them to learn firsthand.

In the simulation center, students have a unique

opportunity to practice and master their skills in

a setting that mimics almost every aspect of real

patient care, except for one crucial feature. In the

simulation center, students can make mistakes and

learn from them risk-free. Here, the only damage

from errors is perhaps a bruised ego.

A POWERFUL TEACHER When you walk into the Mayo

Clinic Multidisciplinary Simulation Center on the

first floor of the Stabile Building at Mayo Clinic’s

campus in Rochester, the setting looks like most

other clinical areas. It has a reception desk, signs

that point you in the right direction, and several

patient exam rooms. But, what happens there is

far from ordinary.

From hands-on guidance, to active role-playing in the operating suite, every scenario within the Simulation

Center is recorded. Together, students and physicians review these and use as learning opportunities.

In this exceptional learning environment, instruc-

tors can simulate almost any medical situation. In

addition to the reception area and the patient exam

rooms, the simulation center has four suites, each

equipped as a different medical area: an operating

room, emergency room, intensive care unit, and

an endovascular lab.

Within these spaces, Mayo educators use several

types of simulation training. Life-size, techno-

logically advanced mannequins are programmed

to show complex findings and react just as a

patient would to treatment decisions. Students

learn surgical or endoscopic procedures, such as

cardiac catheterization or colonoscopy, using the

center’s task trainers. These trainers allow students

to experience the look and feel of performing a

procedure.

Honing interpersonal skills that are key to good

patient care is also part of the simulation center.

Actors play the roles of patients and family mem-

bers so that students can enhance their commu-

nication proficiency in difficult situations, such as

delivering bad news.

“The concept of simulation use in medicine is that

experience is a powerful teacher,” says William

Dunn, M.D., a Mayo Clinic Pulmonary and Critical

Care physician and the simulation center direc-

tor. “Technology can now produce incredibly real,

simulated environments that provide memorable

learning experiences.”

AN IDEAL LEARNING ATMOSPHERE According to Dr.

Farley, the simulation center is an ideal place to

give Mayo Clinic’s surgery residents a chance to

problem-solve in uncommon but critical circum-

stances that require not only surgical skill, but

communication and teamwork, as well.

“When residents are working in the hospital,

there’s no guarantee they will be involved in a

variety of cases,” he says. “The simulation center

allows us to concoct educational experiences, so

our students are ready to handle rare situations

that they may not see otherwise.”

For example, dealing with a lab report from a

pathologist during surgery can be a challenge for

new surgeons. At Mayo, every surgical resident

gets a chance to face that scenario in the simulation

center.

In one simulated situation, students surgically

remove a pancreatic tumor and send the speci-

men to the lab for evaluation to determine if they

extracted all the cancer. They wait in the operating

room for a call from the pathologist. If the report

indicates cancer at the edges of the tissue that was

removed, the students must make a decision.

“At that point, an astute surgeon — assisted by

an astute pathologist — would assess if he or she

should keep going to ensure all the cancer is out,”

says Dr. Farley. “Usually, if there’s cancer at the

edge, you have to take out a little more. But, with

that decision come other considerations. The more

of the pancreas you take, the more likely a patient

is to become diabetic. There are times where it’s

not black and white. We like to explore those gray

zones in the simulation center and test the resi-

dents’ ability to think on their feet in the midst of

a stressful situation.”

A SAFE PLACE FOR MISTAKES After students finish in

the simulation center, a debriefing session follows

in which students and instructors analyze what

happened. Audiovisual equipment in each room

records the simulation, so participants can review

exactly what they said and did. The debriefing is

the most important part of the experience because

students learn ways to improve, and instructors

can raise students’ awareness about what they

may have overlooked or forgotten in the heat of

the moment.

“The really impressive part is that after our students leave

the center, the experiences stay with them.” David Farley, M.D.

“In this setting, it’s okay to make a mistake. In fact,

sometimes it’s great because it gives us a perfect

opportunity to teach,” says Dr. Farley. “The really

impressive part is that after our students leave the

center, the experiences stay with them. Adults

learn better by being involved in a process like this.

Although the simulation center is only one part

of the students’ education, it’s a crucial one. The

realistic situations in the center engage them in a

way that makes a lasting impression and enhances

their ability to use mature judgment — a critical

skill they need as surgeons.”

By using the Multidisciplinary Simulation Center

to teach students ways to respond appropriately

in difficult situations — before they actually have

to face those situations involving real patients

— Mayo Clinic is not only enhancing medical

education, it’s improving patient safety and patient

care quality.

“Simulation is transforming the way we are edu-

cating health care providers,” says Dr. Dunn. “We

expect this to have serious impact on improving

patient safety and outcomes, and we are commit-

ted to being a world leader in this area.”

www.mayoclinic.org/annualreport

At Mayo Clinic, learning isn’t confined to students. To offer the best patient care, all Mayo physicians need to stay on top of advances in medicine. But, with hundreds of journal articles, abstracts, reports and medical news releases published every day, keeping up with new information is a challenge. That’s where Mayo’s Education Tech-nology Center comes in.

The Education Technology Center develops learning technologies to support Mayo Clinic’s five schools and to help Mayo physicians incorpo-rate new medical information into their work.

“Mayo Clinic is built around the concept that no individual has all knowledge,” says Farrell Lloyd, M.D., a General Internal Medicine physician and director of the Education Technology Center.

“The Education Technology Center is based on a collaborative approach to support Mayo as a pro-fessional learning organization.” In that spirit of collaboration, the center gath-ers knowledge from physicians and researchers and disseminates it throughout the organization.

For example, the center has developed a way for physicians who have patients with certain con-ditions, such as long QT syndrome (a dangerous heart disorder), to have online access to current information about the condition, best practices for diagnosing and treating it, and contact details

about Mayo experts on the condition. The infor-mation can be customized, depending on each physician’s practice area.

This project involved developing an application called MayoExpert, using the center’s Enterprise Learning System, a computer-based tool that al-lows the Education Technology Center to connect staff to up-to-date learning resources.

Using the Enterprise Learning System, the center is also creating electronic curriculum for several Mayo education programs. The cur-riculum will allow students to study information related to their clinical work online, while allowing faculty to track students’ progress.

“One of the biggest benefits of the Education Technology Center is that it unifies our teaching,” says Dr. Lloyd. “We know that everyone who uses these technologies is learning the same material developed with input from Mayo experts. It helps ensure that we are teaching what we practice and practicing what we teach. Ultimately, that kind of cohesive approach benefits patients.”

Mayo Clinic offers educational programs and training opportunities on its

three campuses to those pursuing careers in medicine, research and the health

sciences. The College of Medicine at Mayo Clinic includes five schools.

A N S W E R S I N M E D I C A L E D U C A T I O N : 2 0 0 6 N U M B E R S + H I G H L I G H T S

MAYO SCHOOL OF GRADUATE MEDICAL

EDUCATION, the oldest of Mayo’s five schools,

has trained more than 17,000 alumni in virtually

all medical specialties since 1915.

Clinical residents and fellows .......................2,738

MAYO GRADUATE SCHOOL, in operation since

1917, focuses on six biomedical subspecialties.

With an annual average predoctoral enrollment

of 300 students, the school graduates around

50 Master’s and Ph.D. students per year. The

school also serves the educational needs of

visiting predoctoral students and Summer

Undergraduate Research students.

Predoctoral and other students....................... 466

MAYO MEDICAL SCHOOL has trained and

graduated more than 1,000 students since

1972. The school enrolls 42 students per year,

and it also trains visiting medical clerkship stu-

dents and Summer Minority Medical Students.

Medical and other special student categories... 575

MAYO SCHOOL OF HEALTH SCIENCES has

increased its enrollment to over 1,275 students

annually. The school provides training in 30

allied health science programs, offering associ-

ate’s, bachelor’s, certificate, master’s and Ph.D.

level training, as well as clinical internships.

MAYO SCHOOL OF CONTINUING MEDICAL

EDUCATION formally became a school in 1996.

It offers approximately 257 courses and 7,000

hours of continuing medical education each year.

EDUCATION FUNDING SOURCES (in Millions)

Extramural funding............................................ $39

Mayo funds ....................................................... $147

TOTAL FUNDING..............................$186

Mayo Clinic 26 Annual Report

• Mayo Clinic and the U.S. Department of Health

and Human Services, on behalf of the Indian

Health Service, formed a collaboration to work

together to seek ways to reduce the burden of

cancer and other diseases in American Indian

and Alaska Native communities. This national

agreement is the most comprehensive between

the Indian Health Service and another health

care organization.

• All 36 Mayo Medical School seniors who par-

ticipated in the 2006 National Residency Match-

ing Program were successful in matching with

a residency program. Mayo School of Graduate

Medical Education reported that 98.5 percent of

its residency training positions were filled.

• In May, the first radiation therapy and respira-

tory care baccalaureate classes graduated from a

combined Mayo School of Health Sciences/Uni-

versity of Minnesota program. Four radiation

therapists and 10 respiratory care specialists

received their degrees. The collaboration enables

respiratory care and radiation therapy students

to achieve a four-year bachelor’s degree and

professional certification from Mayo School of

Health Sciences.

• Mayo Clinic hosted local high school students

for its second annual Doc Camp in Arizona, in

which students spend time with Mayo physi-

cians and learn about careers in medicine.

• Mayo Clinic partnered with IBM to host a week-

long ExITE camp, which encourages junior high

girls to pursue scientific interests and highlights

opportunities in engineering and technology.

Students met with Mayo researchers, partici-

pated in a variety of projects (including isolating

DNA strands), and viewed machines that create

medical equipment.

• Through a partnership with the University of

North Florida, Mayo Clinic in Jacksonville hosted

the Minorities in Medicine Symposium for promis-

ing 10th grade students from schools in the area.

Students and their parents attended a session to

improve test taking skills, received information

on completing scholarship applications, and were

encouraged to take more rigorous courses.

• Mayo School of Graduate Medical Education

was granted continued accreditation from the

Accreditation Council for Graduate Medical

Education Institutional Review Committee. The

committee acknowledged the school’s continu-

ing efforts to maintain effective institutional

oversight of graduate medical education, com-

mended its multiple best practices, and noted its

support of medical education scholarship.

www.mayoclinic.org/annualreport

Mayo Clinic is driven by its mission of providing the best patient care to

every patient every day through integrated clinical practice, education and

research. As a not-for-profit institution, Mayo invests all of its net operating

income back into programs that support this mission.

M A Y O C L I N I C 2 0 0 6 F I N A N C I A L R E P O R T

O V E R V I E W

During 2006, Mayo Clinic’s income from current

activities — the best measure of Mayo’s financial

performance — was $117 million. This gave the

institution a 1.9 percent operating margin. This

performance was within Mayo’s financial target for

patient care and overall operations. Mayo Clinic

sets its financial targets with the goal of achieving

a return that will allow the institution to meet its

expenses, reinvest in the practice, cover pension

obligations, build its liability reserves, and grow

its endowment.

The number of patients visits at Mayo Clinic grew

by 2 percent to 3 percent across the system. Growth

in expenses outpaced growth in revenue, due in

part to important Mayo investments in patient care,

research activities and information technology

infrastructure. Mayo’s total revenues grew by 8

percent, while expenses grew by nearly 10 percent.

Significant benefactor support for education and

research activities, and strong investment perfor-

mance contributed to the positive overall financial

performance for 2006. This performance also reflects

both strategic investments by the institution in

research and tremendous efforts by Mayo staff

throughout the system to provide the best patient

care in the most efficient and effective manner.

Continued strong financial performance is es-

sential in the coming years to allow for continued

investment in strategic priorities, restore Mayo

Clinic’s financial resources, meet increased pension

payment obligations, and prepare for other finan-

cial challenges that lie ahead, including a growing

number of Medicare patients and a constrained

National Institutes of Health research budget.

OPERATING PERFORMANCE (in Millions)

2006 2005 Percent Change

Total Revenue 6,289.4 5,811.6 8.2Total Expenses 6,172.0 5,615.7 9.9

Income from Current Activities 117.4 195.9

Operating Margin 1.9% 3.4% (1.5)p

INCOME FROM CURRENT ACTIVITIES(in Millions and % of revenue)

$250 5%

200 4%

150 3%

100 2%

50 1%

0

INCOME MARGIN

Target Margin = 3%Minimum = 1.8%

.2%.8%

4.6%

3.4%

1.9%

2002 2003 2004 2005 2006

I N C O M E F R O M P A T I E N T C A R E

Mayo Clinic staff served 521,000 individual

patients in 2006. The total number of patient visits

for all locations was 2.8 million. Patient volumes

grew 2 percent to 3 percent across the system.

Mayo Clinic hospitals admitted 135,000 patients

during the year, an increase of 3,000 admissions.

Income from patient care was down slightly —

$279 million in 2006 compared to $307 million

in 2005. However, overall financial performance

in patient care was consistent with Mayo Clinic’s

multiyear financial plan.

I N V E S T I N G I N R E S E A R C H + E D U C A T I O N

Mayo Clinic’s net operating income is reinvested

to advance the science of medicine and to teach

the next generation of health care professionals.

However, Mayo can’t rely on excess funds from

operations alone to completely fund education

and research.

Overall funding for Mayo research and education

programs was $634 million in 2006, an increase

of $67 million over 2005. Government, founda-

tions and industry sources provided $319 million

of the total amount — a 1.9 percent increase over

2005. Mayo invested $315 million in research and

education in 2006. This includes Mayo funds and

benefactor gifts.

Mayo will continue to partner with foundations,

benefactors, government and industry with mutual

aims to support education programs that train the

next generation of medical professionals and re-

search programs that identify tomorrow’s medical

breakthroughs.

PATIENT CARE OPERATING PERFORMANCE(in Millions)

2006 2005 Percent Change

Total Revenue 5,234.1 4,838.2 8.2Total Expenses 4,955.1 4,531.2 9.4

Income from Patient Care 279.0 307.0

Operating Margin 5.3% 6.3% (1.0)p

INCOME FROM PATIENT CARE(in Millions and % of revenue)

$350 10%

280 8%

210 6%

140 4%

70 2%

0

INCOME MARGIN

Target Margin = 6.7%

Minimum = 4.9%

3.4%

5.2%

6.9%6.3%

5.3%

2002 2003 2004 2005 2006 2006 2005

$634TOTAL

$567TOTAL

$319

RESEARCH AND EDUCATION FUNDING (in Millions)

Mayo Clinic Funds + Benefactor Gifts Extramural Funds

$315

$313

$254

S U P P O R T F R O M B E N E F A C T O R S

More than 87,000 benefactors gave $230 million

in 2006 to support Mayo programs. Support from

grateful patients, foundations, corporations and

other organizations is essential to Mayo Clinic’s

ability to carry out its mission in patient care, educa-

tion and research, to provide outstanding facilities

and technology, and to provide charity care.

E N D O W M E N T

Mayo’s endowment reached nearly $1.3 billion,

growing by more than $260 million during 2006.

The endowment helps provide a stable funding

source for Mayo Clinic research and education

programs. Mayo’s goal is to increase the endow-

ment to $2 billion in coming years. Mayo Clinic’s

endowment is a critical element in providing a

long-term funding base for these programs.

D I V E R S I F I E D A C T I V I T I E S

Mayo Clinic’s diversified activities include health

information publishing enterprises, clinical labo-

ratory reference services, technology commercial-

ization, and other services and products that use

Mayo’s medical and scientific knowledge base.

These diversified activities generated $35 million in

2006, which is reinvested in Mayo Clinic programs

in medical research and education.

C A P I T A L P R O J E C T S

In 2006, Mayo Clinic continued to make signifi-

cant investments in facilities and infrastructure.

Capital expenditures increased by $175 million in

2006 over 2005 levels, totaling $588 million.

The organization continued a number of major

projects during 2006, including construction of a

new hospital in Jacksonville, the build-out of the

Gonda Building in Rochester, the opening of the

Mayo Clinic Specialty Building in Arizona, and

the development of the electronic medical record

in the Mayo Health System. These major projects,

along with technology, medical equipment, major

renovations and projects are fundamental in pro-

viding advanced, quality care to our patients.

I N V E S T M E N T P E R F O R M A N C E

The financial markets made significant gains,

with Mayo’s portfolio returning over 18 percent.

Mayo Clinic’s investments increased in value by

$569 million in 2006. Each year, a portion of the

investment return is used to fund research and

education programs. However, because there is

significant variability of results from year to year,

Mayo can’t rely on strong stock market perfor-

mance as a source of funding for the long-term.

INVESTMENT PERFORMANCE(Annualized Return)

ONE-YEAR THREE-YEAR FIVE-YEAR

General Fund 18.4% 15.6% 12.3%Benchmark 16.3% 13.3% 9.7%

REVENUE , GAINS, AND OTHER SUPPORT:

Net medical service revenue

Grants and contracts

Investment return allocated to current activities

Contributions available for current activities

Premium revenue

Other

Total revenue, gains, and other support

EXPENSES:

Salaries and benefits

Supplies and services

Facilities

Provision for uncollectible accounts

Finance and investment

Total expenses

INCOME FROM CURRENT ACTIV IT IES

NONCURRENT AND OTHER ITEMS:

Contributions not available for current activities, net

Unallocated investment return, net

Change in net deferred tax asset

Asset retirement obligation

Miscellaneous

Total noncurrent and other items

INCREASE IN NET ASSETS (BEFORE OTHER CHANGES IN NET ASSETS)

CHANGE IN MINIMUM PENSION LIABIL IT Y

INCREASE IN NET ASSETS

NET ASSETS AT BEGINNING OF YEAR

NET ASSETS AT END OF YEAR

C O N S O L I D AT E D S TAT E M E N T S O F A C T I V I T I E S YEARS ENDED DECEMBER 31, 2006 & 2005 (IN MILLIONS)

2006

$ 5,300.5

270.5

93.1

130.8

82.0

412.5

$ 6,289.4

$ 4,050.0

1,481.2

478.9

102.0

59.9

$ 6,172.0

$ 117.4

$ 84.9

335.4

2.8

(25.7)

(2.2)

$ 395.2

512.6

12.0

$ 524.6

$ 3,551.7

$ 4,076.3

2005

$ 4,910.7

258.2

78.1

135.7

71.0

357.9

$ 5,811.6

$ 3,648.0

1,329.2

468.2

117.6

52.7

$ 5,615.7

$ 195.9

$ 121.6

194.4

(1.0)

-

(5.9)

$ 309.1

505.0

7.1

$ 512.1

$ 3,039.6

$ 3,551.7

ASSETS

Cash and cash equivalents

Accounts receivable for medical services, net

Investments — at market

Other assets

Property, plant, and equipment, net

Total assets

LIABILIT IES AND NET ASSETS

Accounts payable and current liabilities

Long-term debt

Other long-term liabilities

Net assets

Total liabilities and net assets

MAYO SERVICES AND PEOPLE

Measures of service

Total clinic patients*

Hospital admissions

Hospital days of patient care

People of Mayo (average full-time equivalents)

Staff physicians, medical scientists,

clinical and research associates

Allied health, Residents, fellows and students

Total

* Includes Rochester, Jacksonville and Arizona locations only.

C O N S O L I D AT E D S TAT E M E N T S O F F I N A N C I A L P O S I T I O NYEARS ENDED DECEMBER 31, 2006 & 2005 (IN MILLIONS)

2006

$ 52.8

981.0

3,230.1

835.0

3,126.0

$ 8,224.9

$ 1,058.0

1,445.6

1,645.0

4,076.3

$ 8,224.9

521,000

135,000

619,000

3,000

43,500

46,500

2005

$ 43.1

887.0

2,661.0

776.1

2,862.4

$ 7,229.6

$ 998.4

1,201.7

1,477.8

3,551.7

$ 7,229.6

513,000

132,000

609,000

2,900

42,100

45,000

CHANGE

$ 9.7

94.0

569.1

58.9

263.6

$ 995.3

$ 59.6

243.9

167.2

524.6

$ 995.3

The above summary is intended to present a brief review of Mayo Clinic’s financial condition and activities for 2006 compared with 2005. The Consolidated Financial Statements of Mayo Clinic for the years ended

December 31, 2006 and 2005 were examined by Ernst & Young LLP.

A copy of its report and Mayo Clinic’s financial statement can be obtained by writing to:Treasurer, Mayo ClinicRochester, MN 55905

COST OF BENEFIT PROVIDED TO THOSE IN NEED

Charity care

Unpaid portions of Medicaid and other indigent care programs

Total quantifiable benefit to those in need

COST OF BENEFIT PROVIDED TOTHE BROADER COMMUNIT Y

Non-billed services and cash and in-kind donations

Education and Research **

Total quantifiable benefit to the broader community

Total estimated cost of quantifiable community benefit

Unpaid portions of Medicare and other senior programs

C O M M U N I T Y B E N E F I T S U M M A R Y : BENEFITS TO THOSE IN NEED AND THE BROADER COMMUNITY*YEAR ENDED DECEMBER 31, 2006 (ESTIMATED COSTS STATED IN MILLIONS)

2006

$ 63.9

150.3

$ 214.2

$ 8.6

315.0

$ 323.6

$ 537.8

$ 485.3

* The estimated cost of benefits to those in need and thebroader community were calculated in accordancewith the guidelines set forth by CHA/VHA.

** The estimated cost of education and research excludesexternally sponsored funding that totaled $319 in 2006.

“All who are benefited by community life, especially the physician, owe

something to the community.” Charles H. Mayo, M.D., 1927

C O M M U N I T Y R E L A T I O N S R E P O R T : WORKING TOGETHER TO SUSTAIN A THRIV ING COMMUNIT Y

Mayo Clinic’s founding fathers believed in giv-

ing back to the community. In many ways, Mayo

Clinic and its staff continue the tradition of service

established by Drs. Will and Charlie Mayo. Here

are a few highlights of our year in service:

THE ARTS Using a grant from Mayo Clinic, the

Rochester Art Center is creating a Learning Center

for the Arts. The center will provide arts curriculum

support to teachers of students from kindergarten

through college. • Mayo Clinic provides financial

support to more than two dozen visual and per-

forming arts organizations in Rochester and the

surrounding area.

DIVERSITY Mayo Clinic provides leadership to the

Diversity Leadership Alliance in Arizona, a com-

munity collaborative dedicated to building, empow-

ering and sustaining a community. • Through its

Diversity Interest Groups in Arizona, Mayo Clinic

provides health care and other outreach services,

financial contributions and volunteers for various

community projects. • Mayo Clinic staff work with

Delta Sigma Theta Sorority Inc. and the American

Heart Association to address health disparities in

the Jacksonville community. The groups educated

and screened more than 60,000 people in 2006 on

issues related to heart health and stroke. As part of

this effort, Mayo physicians addressed congregants

in a dozen African-American churches. • Mayo

Clinic supports Study Circles, a community program

in Jacksonville that fosters positive race relations

and understanding. Study Circle participants attend

a series of meetings, during which they are guided

through a curriculum designed to promote under-

standing of differences. Mayo has hosted two Study

Circles on its campus, and plans to host additional

sessions. • Mayo Clinic targeted outreach efforts

to address the educational differences between the

majority and minority communities in Jacksonville.

Through Junior Achievement, staff have presented

programs to assist students in better understanding

the business environment. Additionally, staff have

spoken at career fairs, read-a-thons and educational

workshops. Mayo is a business partner at three lo-

cal elementary schools, providing representation on

School Advisory Committees, donating furniture

and supplies, staffing health fairs, and participating

in reading programs. • Nearly 18,000 children par-

ticipated in Prejudice Reduction workshops, thanks

to financial support from Mayo Clinic and other or-

ganizations in Rochester. Teachers give the program

good grades for engaging students and teaching

the lessons of respect and understanding. • Mayo

Clinic support provided equipment to a Rochester

chapter of the Black Data Processing Associates, a

group that teaches advanced programming skills

to high school students from diverse backgrounds.

This group recently won second place in a national

programming competition.

HEALTH CARE Mayo Clinic provided board leader-

ship, volunteers and financial contributions to the

Arizona Transplant House through fundraisers, di-

rect contributions and a 5K run/walk fitness camp.

• Mayo Clinic staff in Arizona volunteer at the

Society of St. Vincent de Paul health clinic, which

serves homeless and disadvantaged populations.

• Mayo Clinic staff in Jacksonville volunteer at

the Volunteers in Medicine clinic, which provides

health services to the uninsured. • Mayo Clinic

established the Mayo exam room at the Salzbacher

Center for the Homeless in Jacksonville. • Mayo

Clinic provided a start-up grant to Apple Tree

Dental, a nonprofit organization that provides

dental care to people who have special dental-

access needs in Rochester. The grant enables

dentists and hygienists to visit southeastern

Minnesota nursing homes and group homes for the

developmentally disabled to provide care. • Mayo

Clinic provided capital campaign contributions of

$100,000 each to the Ronald McDonald House and

Gift of Life Transplant House in Rochester. The

contributions helped finance needed expansions

at the facilities, which offer long-term, low-cost

housing for patients and family members. • Mayo

Clinic provides financial support, equipment and

volunteers to the Good Samaritan Medical and

Dental Clinics, which provide medical and dental

care to those who lack resources to pay for health

care in Rochester.

HUNGER Mayo Clinic employees in Arizona do-

nated hundreds of pounds of food to the Joshua

Tree Food Shelter, the Ronald McDonald House

and the Mesa Men’s Shelter. Mayo Clinic Arizona

also supports food banks and meal programs for

the homeless and underserved through the Society

of St. Vincent de Paul. • Mayo Clinic’s support for

Channel One Food Shelf helped launch a much-

needed warehouse expansion effort in Rochester.

In addition, Mayo employees contributed 4,586

pounds of food to Channel One.

SERVING THE UNDERSERVED As part of the seventh

annual Big Hearts Warm Small Hands collection

event, Mayo Clinic employees in Rochester donated

warm winter outerwear to more than 500 families.

• Mayo Clinic helped fund scholarships for five

students, the first graduates from the community

health worker program at Rochester Community

and Technical College. This program prepares

graduates to help people from diverse cultures

gain better access to the health care system.

UNITED WAY Each year, Mayo Clinic sponsors a

United Way fundraising drive. In 2006, Mayo

Clinic employees pledged nearly $1.4 million to

the United Way. The total contribution of $1.75

million was the largest United Way contribution

in Mayo Clinic history.

YOUTH Together with the University of North

Florida, Mayo Clinic in Jacksonville hosts a

Minorities in Medicine Symposium for 10th graders

and their parents. More than 60 students attended

the symposium in 2006. • Mayo Clinic made a

capital campaign donation to the Gamehaven

Council of Boy Scouts, which will help construct

a community building on the council’s 262-acre

camp near Rochester. The building will enable the

council’s 5,000 scouts to participate in year-round

activities. • A contribution from Mayo Clinic

helped jump-start First Steps, a community effort

for early childhood development in Rochester.

Today much is being written about quality in health care, and the need

to improve what we do and how we do it. A number of organizations,

including the government, have been measuring physicians and hospitals

to determine if their performance is the very best it can be.

O U T C O M E S T H A T M A T T E R : QUALIT Y HEALTH CARE IMPROVEMENTS SAVE L IVES

This has led to a number of pay-for-performance

projects sponsored by government purchasers such

as Medicare and Medicaid; large employers who

purchase health care for their employees; and health

care coalitions. In these projects, providers are paid

for doing very specific things for patients in a very

specific way, with an emphasis on the processes

of care. Recently, Denis Cortese, M.D., president

and CEO of Mayo Clinic, and Robert Smoldt, the

clinic’s chief administrative officer, explored this

phenomenon in a commentary they published in

Mayo Clinic Proceedings, entitled Pay-for-Performance

or Pay for Value? They emphasize that it’s patient

outcomes — not process — that should be the focus

of quality improvement efforts.

“Most of these incentive programs target a mix of

process and structural measures with less emphasis

on patient satisfaction and overall patient outcomes.

Programs have varying payment approaches, but

quality bonuses are most common. In this scenario,

payers give physicians and medical institutions an

annual ‘bonus’ or percentage for meeting a goal

(such as prescribing aspirin at discharge after an

acute myocardial infarction) or withhold a small

percentage of payment until requirements are met.

Mayo Clinic recently hosted its first National

Symposium on Health Care Reform, at which 300

national leaders convened and reached consensus

on the direction that reform must take. Two of the

key recommendations dealt with value. Partici-

pants agreed that the health care system needs to

deliver value to all stakeholders and that payment

should be based on results of coordinated care

delivered over time.

We must move away from pay-for-performance

approaches that reward process achievement

and move toward paying for value. Patients want

health care that is a good value — high-quality

health care (good outcomes, safe care, and great

service) at a reasonable price.”

This value equation would move away from the

current emphasis on processes and focus instead

on patient outcomes. Improving processes of care is

still important, but making sure that the processes

result in improved care for patients will result in

increased value and increased patient satisfaction.

An example of this is Mayo Clinic’s STEMI project:

a time-shaving approach to help more patients

survive the most serious heart attacks.

The goal: Streamline care so time elapsed from

when a patient enters the emergency depart-

ment door to the moment a tiny balloon opens

a blocked artery in the cardiac catheterization

laboratory — balloon angioplasty — is 90 minutes

or less. Few hospitals (less than 40 percent for

non-transferred patients and less than 5 percent

for transferred patients) meet this objective. The

approach is dubbed door-to-balloon (D2B) time.

The American College of Cardiology in collabo-

ration with the American Heart Association and

other organizations launched a national campaign

to improve D2B times in 2006.

Mayo Clinic began its initiative in 2004, according

to Henry Ting, M.D., the Mayo cardiologist who

headed the multidisciplinary team effort. In two

years, the median D2B time decreased from 92

minutes to 60 minutes for patients who come to

Saint Marys Hospital in Rochester.

This quicker response saves the lives of patients

with ST-elevation myocardial infarction (STEMI),

a type of heart attack with total blockage of an

artery (about 20 percent of all heart attacks).

“Every 30-minute delay before opening the artery

increases relative mortality by 8 percent,” says Dr.

Ting. “For these patients, time is muscle damage,

time is cell death, and every minute counts.”

Dr. Ting’s team also focused on improving results

regionally. “Even with our efforts here, we weren’t

helping most of the people in the region,” says Dr.

Ting. That’s because most community hospitals,

where patients go first, aren’t equipped to perform

balloon angioplasties.

The solution was Fast Track for Heart Attack. Mayo

Clinic coordinates with 28 regional hospitals

within 200 miles. When a patient’s electrocardio-

gram indicates a STEMI, the Fast Track protocol

kicks in. The community hospital starts the right

medications and activates the Fast Track with a

single phone call. The air ambulance transport

and preparations for an angioplasty procedure in

Rochester are set in motion.

The median D2B time within 200 miles of Mayo

Clinic is 108 minutes, compared to 180 minutes

nationally. Sixty of the 108 minutes are to transport

the patient to Rochester via helicopter.

“STEMIs are one of the true medical emergencies,”

says Dr. Ting. “By streamlining the care, we’ve been

able to dramatically improve outcomes.”

“By streamlining the care,

we’ve been able to dramatically

improve outcomes.” Henr y Ting, M.D.

Robert E. Allen

Retired Chair and CEO

AT&T

Basking Ridge, N.J.

James L. Barksdale

Chair

Barksdale Management

Corporation

Ridgeland, Miss.

Barbara M. Barrett

Chair

U.S. Advisory Commission

for Public Diplomacy

Phoenix, Ariz.

John H. Dasburg

Chair and CEO

ASTAR Air Cargo, Inc.

Miami, Fla.

Senator Thomas A. Daschle

Special Policy Advisor

Alston & Bird, LLP

Washington, D.C.

A. Dano Davis

Former Chair, Board of Directors

Winn-Dixie Stores, Inc.

Jacksonville, Fla.

Louis L. Gonda

President

Lexington Commercial Holdings

Beverly Hills, Calif.

Jerome H. Grossman, M.D.

Senior Fellow

JFK School of Government

Cambridge, Mass.

Roy A. Herberger, Ph.D.

President Emeritus

Thunderbird, The Garvin School

Phoenix, Ariz.

Patricia E. Mitchell

President and CEO

The Museum of Television & Radio

New York, N.Y.

Marilyn Carlson Nelson

Chair and CEO

Carlson Companies, Inc.

Minneapolis, Minn.

Luis G. Nogales, J.D.

Managing Partner

Nogales Investors, LLC

Los Angeles, Calif.

Ronald L. Olson

Munger, Tolles & Olson, LLP

Los Angeles, Calif.

Hugh B. Price

Senior Fellow

Brookings Institution

Washington, D.C.

Lee R. Raymond

Retired Chair of the Board

ExxonMobil Corporation

Irving, Texas

Anne M. Tatlock

Chair and CEO

Fiduciary Trust Company

International

New York, N.Y.

2 0 0 6 M A Y O C L I N I C B O A R D O F T R U S T E E S

P U B L I C T R U S T E E S

Nina M. Schwenk, M.D.

Vice President, Mayo Clinic

Consultant, General Internal

Medicine

Mayo Clinic Rochester

Craig A. Smoldt

Chair, Department of Facilities

Support Services

Mayo Clinic Rochester

Robert K. Smoldt

Vice President and Chief

Administrative Officer

Mayo Clinic

Victor F. Trastek, M.D.

CEO

Mayo Clinic Arizona

Shirley A. Weis

Vice Chair, Administration

Mayo Clinic Arizona

A D D I T I O N A L O F F I C I A L S

Jeffrey W. Bolton

Chief Financial Officer

Chair, Department of Finance

Mayo Clinic

Michael J. McNamara

Chair, Department of Development

Mayo Clinic

John H. Noseworthy, M.D.

Medical Director for Development

Mayo Clinic

Jonathan J. Oviatt, J.D.

Secretary

Chair, Legal Department

Mayo Clinic

George B. Bartley, M.D.

CEO

Mayo Clinic Jacksonville

Denis A. Cortese, M.D.

President and CEO

Mayo Clinic

Glenn S. Forbes, M.D.

CEO

Mayo Clinic Rochester

Jeffrey O. Korsmo

Chief Administrative Officer

Mayo Clinic Rochester

Jack P. Leventhal, M.D.

Consultant, Pulmonary Medicine

Mayo Clinic Jacksonville

Leslie N. Milde, M.D.

Consultant, Anesthesiology

Mayo Clinic Arizona

Robert E. Nesse, M.D.

President and CEO

Franciscan Skemp Healthcare

Mayo Health System

Franklyn G. Prendergast, M.D., Ph.D.

Director

Center for Individualized

Medicine Research

I N T E R N A L T R U S T E E S

E M E R I T U S P U B L I C T R U S T E E S

Lilyan H. Affinito

Ambassador Howard H. Baker Jr.

H. Brewster Atwater Jr.

Barbara P. Bush

Catherine B. Cleary

Allan R. DeBoer

George C. Dillon

Frances D. Fergusson, Ph.D.

Bert A. Getz

Hanna H. Gray, Ph.D.

Robert A. Hanson

W. Thomas Johnson Jr.

Sister June Kaiser

Richard L. Knowlton

Philip R. Lee, M.D.

Whitney MacMillan

Joan D. Manley

Charles T. Manatt

J. Willard Marriott Jr.

Ambassador Donald F. McHenry

Newton N. Minow

Honorable Walter F. Mondale

Frederick W. Smith

Edson W. Spencer

Donald M. Stewart, D.P.A.

Paul A. Volcker

Rawleigh Warner Jr.

Robert C. Winters

Mayo Clinic is committed to providing the highest-quality medical care.

Our mission — to provide the best care to every patient every day through

integrated clinical practice, education and research — captures what the

organization has stood for throughout its history. The patient is the focus ofeverything we do.

Four organizational priorities in 2007 are aimed at ensuring that our patient

focus permeates the entire organization, in every department at every loca-

tion. Mayo Clinic will focus significant effort on improving its ability to:

T H E Y E A R A H E A D

Connect as a unified organization with multiple locations so that wherever patients are seen, they have the same experience andknow that they have access to all of Mayo Clinic’s resources.

Build its culture of teamwork and quality across the institution,so that every practice is examined to ensure that it contributes the highest-quality care and service.

Search for answers for every patient through individualized medicineso that Mayo can better understand disease differences at the genetic level, enabling Mayo to personalize treatments more effectively.

Transform the science of health care delivery by improving and sharing what it has learned for the benefit of the entire organization and all of medicine.

1 . W O R K I N G A S O N E

Mayo Clinic is one organization with multiple

locations. No matter where patients are seen,

they should experience Mayo’s model of care

— the highest-quality care and personal service

— and know that they have access to all of the

resources of Mayo Clinic.

Inside the organization, Mayo is motivated by

common goals and values, with staff at all

locations dedicated to working together for our

patients. Historically, Mayo Clinic has excelled at

bringing together teams of specialists to diagnose

and treat the most difficult medical conditions.

Today, with specialists in virtually every medical

specialty committed to collaboration, and con-

nected through common goals and the latest

technology, Mayo has resources unmatched by

any other medical institution.

2 . C U L T U R E O F T E A M W O R K + Q U A L I T Y

Mayo Clinic has always been synonymous with

quality. As an organization, Mayo has a culture

of teamwork and quality that allows it to pursue

excellence in patient care, to make important dis-

coveries and apply the latest medical knowledge,

and to provide great service.

The challenge today is to build on advances in

teamwork and quality to create lasting improve-

ments, spread throughout the organization, that

deliver the best outcomes, the safest medical

care, and the best in service. Delivering the best

outcomes in the most efficient and cost-effective

manner creates the best value in medical care.

3 . I N D I V I D U A L I Z E D M E D I C I N E

Modern medicine has made great strides in link-

ing clinical and biological data to improve our

ability to predict an individual’s susceptibility

to disease, onset and progression of disease, and

likely response to therapies.

In the coming years, even more will be possible

by taking advantage of the rapidly increasing

understanding of our genetic makeup, and

developing more sophisticated information sys-

tems and tools to allow Mayo Clinic to predict

better outcomes.

4 . S C I E N C E O F H E A L T H C A R E D E L I V E R Y

Mayo Clinic is poised to transform medicine in

the 21st century. As the Mayo practice developed,

it built on excellent care for patients with a uni-

fied patient record, advanced communications

and scheduling systems, and facilities designed

to support and strengthen the practice of Mayo

staff.

Mayo is creating the future of patient care by

continuing to apply expertise not only to epi-

sodes of care but to the systems and processes

that support the delivery of care. The goal is to

improve the quality of our care, to improve the

safety of our care, and to improve service we

provide to patients. Mayo Clinic brings science

to health care delivery through the study and

application of process improvement and systems

engineering principles, increasing the value of

the care we deliver.

C O N T R I B U T I N G T O A N S W E R S

People have always come to Mayo Clinic for answers,

for diagnoses, for treatments, for cures. Thanks to

benefactor support, people can continue to rely on

the excellence of Mayo Clinic.

www.mayoclinic.org/annualreport

Philanthropic support touches virtually every

aspect of life at Mayo Clinic, and its benefits reach

far beyond our walls. Every day, Mayo is at work

— researching and teaching, sharing innovations,

caring for patients and consulting with medical

professionals around the world. A gift to Mayo is

an investment in people.

Today, more than ever, philanthropy is essential to

making progress in patient care through research

and education at Mayo Clinic. Benefactor support

enriches our programs and helps keep Mayo on

the cutting edge of medical science. Our benefac-

tors are partners in our mission. Their generosity

helps nurture our commitment to provide the

best care to every patient every day through

practice, education and research. Together we are

making a difference in the lives and the hopes of

so many in need.

“We support Mayo now to help oth-

ers. We give to multiple myeloma

research in the hopes of one day

finding a cure.” Tom + Linda Garret t

“People from all over the world come

to Mayo when they’ve failed to be

treated elsewhere. When I go to

Mayo, I know I’m going to receive

the best care possible. There’s a

human touch that you just don’t

get anywhere else.” Helen Houle